Advance directives and cancer decision making near the end of life

Seriously ill individuals, including those seriously ill with cancer, are frequently encouraged to complete instructional advance directives (i.e., living wills) to ensure that their wishes about the use of life-sustaining treatment are honored if they should lose the ability to make decisions for themselves. The authors present a social psychological analysis making explicit a series of steps that must necessarily take place if living wills are to honor the wishes of incapacitated patients. They then focus on 3 key steps in the analysis and review relevant research from the medical and psychological literatures. In each case, this research raises serious questions about the psychological assumptions underlying the effective use of living wills in end-of-life decision making. Discussion focuses on the need for policy and law guiding the use of advance directives to be informed by both basic and applied research on judgment and decision making.